Paramanandam, V.S., & Dunn, V. (2014). Exercise for the management of cancer-related fatigue in lung cancer: A systematic review. European Journal of Cancer Care, 24, 4–14. 

DOI Link


STUDY PURPOSE: To study the effect of exercise intervention on cancer-related fatigue in patients with lung cancer 
TYPE OF STUDY: Systematic review 

Search Strategy

DATABASES USED: CENTRAL, PubMed, Embase, CINAHL, Web of Science, ScienceDirect, and SPORTDiscus; reference list of the identified journals and previous reviews were searched for any potential articles; weekly automated search alerts were created for databases that provided the service.
KEYWORDS: Exercise, cancer-related fatigue, and lung cancer. These key terms were used to create an exhaustive list of keywords; later, the Boolean Operators \"AND\" and \"OR\" were used effectively to focus or broaden the query in electronic search strategy.
INCLUSION CRITERIA: Population studies that evaluated the effect of exercise on cancer-related fatigue in adults of any age with lung cancer regardless of gender, tumor stage, and type of cancer treatment. Participants may have been actively receiving treatment, be in long-term follow-up, or be receiving palliative care. Intervention studies that reported the effect of physical exercise on cancer-related fatigue. The intervention could take place in any setting and be delivered to a group or individual participant. All types of physical exercise were considered for inclusion, including aerobic exercise, strength training, and flexibility exercises. Comparison studies that compared exercise with no exercise, a usual care group (i.e., no specific exercise program prescribed), or an alternative treatment for fatigue associated with cancer.
Outcomes studies in which cancer-related fatigue was measured by patient-reported assessment tools. Study designs included all study designs except cross-sectional studies and surveys.
EXCLUSION CRITERIA: Abstracts and unpublished data were not included.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 453 studies; the reference list search identified another 40 potential studies. After the removal of duplicates and irrelevant studies, 331 studies were included for further screening. Screening of the title and the abstract for exercise intervention on lung cancer excluded 284 studies from the review. The remaining 47 articles were considered for full-text review; however, full-text for 13 studies could not be retrieved (11 abstracts and 2 studies not available through the Oxford and Oxford Brookes University Library) and another 24 studies were excluded because they did not meet the inclusion criteria.
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Levels of Evidence developed by the Oxford Centre for Evidence Based Medicine (all five levels) was used to evaluate the selected studies. Data extraction was performed and rechecked by one reviewer and supervised by another reviewer. Reviewed studies’ quality ranged from 50% to 83.33%.

Sample Characteristics

  • KEY SAMPLE CHARACTERISTICS: Adults with lung cancer

Phase of Care and Clinical Applications

  • PHASE OF CARE: All phases
  • APPLICATIONS: Elder care, palliative care


Three of the 10 studies showed a significant reduction in fatigue with exercise, one using aerobic exercise, one using chest physiotherapy, and one using pulmonary rehab. The other studies showed improvement but did not reach statistical significance. All studies were level 4 or 5 evidence (low). Studies with significant results, however, were not similar in their exercise intervention. Exercise was safe and feasible for adults with lung cancer. All studies provided exercise under supervision, and most included aerobic and interval training


\"This current review shows that exercise is beneficial and safe in lung cancer-related fatigue; however, the studies are small and, without any control groups, are lacking clinically significant effects. Thus, exercises could be used in the management of cancer-related fatigue in lung cancer in view of the available evidence in other cancer cohorts with due caution. There is an urgent need of further research with adequate sample size, preferably randomized controlled trials, to evaluate the effect of exercise in this cancer cohort” (p. 10).


  • Small number of studies
  • Small sample sizes
  • Most studies without randomization or control groups
  • Studies retrieved and reviewed by one student and advisor

Nursing Implications

In light of studies on the effects of exercise in other diseases, exercise can be considered for the management of fatigue in patients with lung cancer with attention to performance status. Patients perhaps should undergo individual testing and exercise prescription. Additional research is needed.

Legacy ID